Hi,On the CBS News new website on AIDS, they have some interviews with Doctor Fauci and Ho who say many things, inlcuding the great news that there are some new integrase and fusion drugs that will overcome resistance which will be available in the next few years. This sounds exciting! Are we really that close to new types of fusion and integrase drugs? Will these drugs be easier to take than Fuzeon/T-20???

Response from Dr. Sherer

It is true that the latest generation of drugs that
block the entry of virus into cells by a variety of mechanisms are making progress in clinical trials. Large scale trials are in planning for the most advanced compounds. It is also true that they have some advantages over T-20, most notably being available for oral dosing rather than injections.

It would not be correct, however, to say that they can 'overcome resistance' of the virus to current HIV medications, as they have a completely different mechanism of action. NRTI, NNRTI, and PI resistance mutations will not be affected by this class of drugs.

It is true, however, that their use may help to overcome the problem faced by people who have had many ART regimens and are highly resistant to the current classes of drugs.

Also in the pipeline are new agents in the existing classes (NRTIs, NNRTIs, and PIs) that have activity against these same multi-resistance viruses. At the recent ICAAC and Glasgow conferences, the results of the major trials of tipranavir, a new protease inhibitor with activity against multi-PI resistant strains, were presented.
In about one third of patients, full viral suppression was accomplished after 48 weeks of treatment with tipranavir (in combination with the booster ritonavir 200mg twice daily) and intestigator-selected new NRTIs. Importantly, those patients in whom Fuzeon (T-20) was also used, i.e. in whom there were 2 active classes of drugs, including one new class (T-20), had the best results in the
US trial, with almost one half of patients having full viral suppression.

Tipranavir is likely to be approved on the strength of these data in 2005, and available for compassionate release as well.

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